Der Schmerz
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Cluster headache (CH) is a highly debilitating headache disorder characterized by frequent attacks of excruciating unilateral pain accompanied by cranial autonomic symptoms. Calcitonin gene-related peptide (CGRP) is implicated in the pathophysiology of CH. ⋯ Galcanezumab had a significant effect in the prevention of eCH attacks but not in cCH. Possible reasons for this discrepancy are discussed.
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Although psychosocial factors have a profound impact on the experience of pain and pain recovery, the transfer to clinical application has so far been insufficient. With this article, a task force of the special interest group "Psychosocial Aspects of Pain" of the German Pain Society (Deutsche Schmerzgesellschaft e. V.) would like to draw attention to the considerable discrepancy between existing scientific evidence on the importance of psychosocial factors in the development of chronic pain disorders and the translation of these findings into the care of pain patients. ⋯ In this way, modern, integrative and complex pain concepts can reach the patient. Based on these fundamental findings on the importance of psychosocial factors in pain and pain treatment, implications for the transfer to clinic and further research will be shown.
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In the field of headache disorders, the term "fear of attacks" refers to the fear of a headache attack occurring. Excessive fear of attacks may worsen the course of a migraine and lead to an increase in migraine activity. In the assessment of attack-related fear, a categorical (fear of attacks as a specific phobia) and a dimensional approach (measuring the extent of fear using a questionnaire) are available. ⋯ The treatment of attack-related fear includes behavioral interventions as well as pharmacological therapy. Behavioral interventions have few side effects and are based on the treatment of common anxiety disorders (e.g., agoraphobia). Although the evidence of existing treatments is sparse, attack-related fear should be considered in routine care.
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The article provides an overview of the research project "Metaphor in end-of-life care", which was conducted at Lancaster University (UK) between 2011 and 2014. The goals of the project were to show a) how patients, family members and healthcare professionals use metaphors to talk about their experiences with and expectations of end-of-life care, b) what experiences and needs are suggested by the use of metaphors by these groups and c) what contribution the results can make to communication in the healthcare system. ⋯ The use of metaphors by these groups suggests a need for solidarity and community and reflects both positive and negative personal experiences. Resilience can be understood as resistance against illness or as acceptance of it.
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Narrative Medicine is an interdisciplinary concept that joins literary texts and theory on the one hand with medical education on the other. It suggests that specific skills can be practiced by reflecting about literature and the arts, which represent existential human experiences. These skills are narrative competence, tolerance for ambiguity, changing one's perspective, empathy, and self-care. ⋯ Literary texts in a medical classroom can be a productive resource to practice and critically discuss competences identified in the National Competency-Based Learning Objective Catalogue for Medicine 2.0.